Pelvic instability, hypermobility and SPD

Whilst it`s relatively easy to loosen a joint which has become too tight, more time and management are needed for joints which are too loose.....hypermobile.

Pre & Post Partum Hypermobility. The hormone Relaxin is produced from the end of the first trimester. Whilst post-partum ligamentous tightening is spontaneous, certain assymetric strains & activities, e.g. holding the child on one hip, can lead to continued hypermobility

Congenital Hypermobility

Risser tests grade naturally loose ligaments according to thumb/wrist adduction. Whilst amusing, "double joints" can predispose to sprain/strain injuries especially in the unfit.These may only "surface" in later life as youthful muscle tone is lost.

Traumatic Hypermobility (>1st degree sprains )

Acute sprains may be inflicted by RTA`s, horse falls etc. However, chronic sprain may be sustained unconsciously from repetitive work or postural stress. (eg standing with the weight through one hip). aka microtrauma,

Acquired Hypermobility (ballet dancers, gymnasts).

These individuals tend to be naturally flexible, however sustained training when young will confer extreme hypermobility, usually OK whilst there is strongly developed postural musculature. Problems tend to arise when this muscle tone is lost in later years.

Degenerative Hypermobility

Chronic loss of lumbar disc height leads inexorably to facet degeneration and osteophytic changes. Foraminal encroachment can cause physical or metabolic nerve root compromise, leading to relative weakening of lower extremity and pelvic girdle musculature. This weakening adds pelvic instability to an existing lumbar problem.

Too much movement causes joint centres of rotation to shift, leading to aberrent motion and excessive cartilage wear. Irritation and oedema cause capsule mechanoreceptors to fire, leading to joint splinting..."the arthrokinetic reflex". Splinting muscles soon tire and pull at their tendonous insertions (enthesiopathy) as well as developing active trigger points and fibrosis. Eventually they`re incapable of stabilising the joint and painful "clunking" joints develop.

Treating hypermobility requires the joint be held in the correct position for natural ligamentous balance to re-establish, without holding the joint too tight.

Hold too tight and the natural movement of the joint is compromised. Because synovial fluid exudes into the joint largely due to the pressure variance resultant from movement, restricting movement gives:

• Stasis of synovial fluid, and build up of metabolic toxins, giving irritation and edema.
• Increased friction > in greater cartilage erosion
• Decreased chondrocyte metabolism > decreased cartilage repair
• Rapid cartilage degeneration > increased friction.........The vicious circle progresses.

Made of inelastic cotton webbing for stability, with elastic side tensioners to provide the optimum joint movement. The Serola Back Pain Belt "normalises" the movement of the joint, allowing natural rest and repair of the joint`s soft tissues:

In correct alignment, the sacrum nutates freely with ambulation and respiration, helping create"the sacral pump" responsible for circulation of CSF around the spinal cord. Both hyper & hypomobility can compromise this system leading to decreased nutrition of nerve roots in the spinal canal. ( Rydevik 1984) estimates that CSF is responsible for 80% of nerve root nutrition in the canal) Thus worrying non-specific neurological finding might be expected to arise in chronic SI patients.